A. Immediate determinants (diet and disease)
The immediate causes of under nutrition are inadequate dietary intakes and health status. They interact: disease, in particular infectious disease, affects dietary intake and nutrient utilisation.
In most cases under nutrition is the combined result of inadequate dietary intake and health status. Not included in the conceptual framework ‘boxes’ are a range of possible demographic and community factors. Figure 7, which depicts the Conceptual Framework, proposes some of the major interventions that could have an impact on the immediate causes.
Figure 7: Conceptual framework of basic, underlying and immediate causes of child under nutrition
Food Consumption
The main source of data on the nature of food consumption at the national level is the NFCNS (Maziya-Dixon B, et al 2003). Information was collected using household questionnaires, 24-hour dietary recall (qualitative), and anthropometry and biochemical measurements. In the dry savannah zone, the main crops consumed were maize, rice cassava, cowpea and sorghum, although in the five Programme states, the semi arid crops of sorghum, millet and cowpeas generally form the bulk of the diet. Sorghum is confirmed as the most frequently consumed staple food crop (over four times a week) for the dry savannah, followed by maize and rice. Among the legume staple crops (the major source of plant protein) in the dry savannah, the most frequently consumed legume was cowpea. The most frequently consumed, non staples were fruit, leafy and non leafy vegetables, meat and fish, and fats and oils. Although fruit ranked second at (to non leafy vegetables) in the overall frequency of consumption percentages in the dry savannah, a majority of households consumed fruit once or twice a week. Only non leafy vegetables and fats and oils were consumed four times a week (see NFCNS pages 11-26). There is however, a considerable diversity of fried snacks. Better off families would be able to consume some meat. Breast feeding is rarely exclusive but many children are weaned comparatively late, usually onto the household staple meals.
Otherwise there is a dearth of national surveys providing data sets that can be used for analysis of food and nutrition security in rural Nigeria. Many studies are carried out without including information on per capita consumption, food distribution and availability at the household level (Akinyele, 2009). One survey of settled communities and pastoralists among four Fulani hamlets on the Jos Plateau (Glew et al, 2004) found that urban subjects consumed more calories than rural subjects (men: 2061 vs. 1691 kcal; women: 1833 vs. 1505 kcal) and had a significantly higher mean body mass index (BMI) and percentage of body fat than rural subjects. Both urban males and females had carbohydrate intakes that were greater than those of Fulani pastoralists (men: 56% vs. 33% total calories; women: 51% vs. 38% total calories), but had a significantly lower dietary intake of total fat and saturated fat (men: 36% vs. 51% of total calories; women: 40% vs. 51% of total calories). With the exception of HDL-cholesterol levels, which were significantly lower in the rural population, the blood lipid profiles of rural subjects were more favourable compared to those of urban subjects.
Protein intake of children in the North Western zone is low because their diet is mainly cereal-based with no supplementation (Anigo et al, 2009). Ready to eat complementary food samples were collected from mothers with children older than 6 months but younger than 24 months and evaluated for its nutrient components using standard procedures. Results obtained showed that guinea corn and millet paps were the first foods introduced to children in the zone.